Fady Boules, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2022019939 Issued in MO

Practice address

1600 Wentzville Pkwy Ste 101
Wentzville, MO 63385-3429

Phone

(636) 445-3063

NPI assigned

Jun 4, 2022

Last updated

Jun 4, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: fady.boules.p1@direct.affiniahealthcare.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654300800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654300800000",
    "number": "1912646134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1411 WINDGATE WAY LN",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630054496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WENTZVILLE PKWY STE 101",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853429",
            "telephone_number": "636-445-3063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULES",
        "first_name": "FADY",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-04",
        "last_updated": "2022-06-04",
        "certification_date": "2022-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2022019939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.